Headaches and What You Need to Know!

Graphic of women stretching with toddlers
Posted June 26, 2024
Jennifer Stemmler
BSc(Kin), MSc(PT)

Headaches are some of the most common complaints that we see in the clinic – it comes as no surprise, as headaches are one of the most prevalent conditions documented in the literature. In fact, 7/10 people will experience a headache at some point in their lifetime. There are three main types of headaches that we typically see at Elora Physiotherapy: tension type headaches, cervicogenic headaches, and migraines.

Tension type headaches (TTH) are some of the most common headaches that people experience, with most individuals encountering this headache at some point in their life. The mechanism of how these headaches occur is not well understood, however, they have been linked to trigger points in the muscles of the head and neck. This can create pain and tightness through the area and refer into the head. These muscles include the frontalis, temporalis, masseter, pterygoid, sternocleidomastoid, splenius, and/or trapezius muscles. TTH can be episodic in nature, or occur chronically for some people, with headaches lasting anywhere from a few minutes to a few days at a time.

Individuals experiencing TTH may complain of:

  • Pressure or tightness impacting both sides of the head and/or neck
  • Light or sound sensitivity
  • Decreased neck range of motion or strength (although this is more common and pronounced with a cervicogenic headache)

Cervicogenic headaches differ from TTH in that they are considered a secondary headache – this means that the headache is caused by a medical dysfunction in the neck. This can be the result of an injury/lesion/disorder impacting the joints, ligaments, capsule, disc, or soft tissue of the upper cervical spine. This is usually confirmed with imaging.

Individuals experiencing cervicogenic headaches may complain of:

  • Pain on one side of both sides of the head
  • Light or sound sensitivity
  • Decreased upper cervical range of motion or strength
  • Decreased muscular control of upper cervical spine

It can be difficult to differentiate this type of headache from a TTH or a migraine without imaging or a thorough examination.

Migraines are incredibly complex, and as they are considered a chronic pain disease, their mechanism of action is not well understood. They are thought to be linked to many factors, including genetics, blood flow, and hormones. Migraines are the third most prevalent disorder in the world, creating significant disability for those suffering with them. A migraine can be present with or without an aura, a set of sensory symptoms consisting of visual changes or physical sensations that occur prior to a migraine attack. Symptoms of a migraine can vary greatly, and do not always include having a headache.

Individuals experiencing migraines may complain of:

  • Unilateral throbbing or pulsing head pain
  • Dizziness/vertigo
  • Nausea/Vomiting
  • Sensitivity to light or sound
  • Fatigue
  • Pain/pressure/ringing in ears
  • Visual changes

Treatment: Clinically, there are a lot of options for how to help manage and treat headaches. Because headaches can be a persistent condition, treatment often extends outside of the clinic to include lifestyle modifications to help prevent and treat headaches independently – this includes aerobic/breathing/therapeutic exercise, sleep hygiene, stress management and activity modifications. 

Recent literature supports the use of physiotherapy for conservative management of these types of headaches:

  •  A 2022 review and meta-analysis by Jung et al. demonstrated that the use of combined physiotherapy techniques, including massage, joint mobilization, dry needling, neural mobilization, TENS, and exercise was beneficial in reducing the intensity and frequency of TTH
  • Jung at el. demonstrated that the use of manual therapy in combination with exercises has also been shown to be effective for the treatment of cervicogenic headache.
  • Migraines often require more intensive medical management due to its complex and persistent presentation, however Meise et al demonstrated that physiotherapy in combination with pain neuroscience education has been shown to assist in reducing the frequency of migraines
  • As well, due to the musculoskeletal findings in individuals who suffer with migraine, physiotherapy can be useful in the management of symptoms when someone is experiencing a migraine attack.

If you are suffering with persistent or recurring headaches, please contact us – we are here to help you feel better!


  1. Headache Classification Committee of the International headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia . 2018;38(1):1-211.
  2. Fernandez-de-las-Penas C, Cook C, Cleland JA, Florencio LL. The cervical spine in tension type headache. Musculoskelet Sci Pract. 2023;66:102780.
  3. Anarte-Lazo E, Carvalho GF, Schwarz A, Luedtke K, Falla D. Differentiating migraine, cervicogenic headache, and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021; 22(1): 755.
  4. Jung A, Eschke RC, Struss K, Taucher W, Luedtke K. Effectiveness of physiotherapy interventions on headache intensity, frequency, duration, and quality of life of patients with tension-type headache. A systematic review and network meta-analysis. Cephalalgia 2022; 42(9):944-965.
  5. Jung A, Carvalho GF, Szikszay TM, Pawlowsky V, Gabler T, et al. Physical therapist interventions to reduce headache intensity, frequency,a nd duration in patients with cervicogenic headache: a systematic review and network meta-analysis. Physical Therapy 2023; 104(2): 1-15.
  6. Meise R, Carvalho GF, Thiel C, Luedtke K. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: a randomized controlled trial.Cephalalgia 2023; 43(2).